When to see your GP

It's important to see your GP if you experience the early symptoms of peripheral neuropathy, such as:

pain, tingling or loss of sensation in the feet

loss of balance or weakness

a cut or ulcer on your foot that isn't getting better

It's also recommended that people at highest risk of peripheral neuropathy, such as people with diabetes, have regular check-ups.

Your GP will ask about your symptoms and may arrange some tests to help identify the underlying cause. You may be referred to hospital to see a neurologist (a specialist in conditions affecting the nervous system).

Generally, the sooner peripheral neuropathy is diagnosed, the better the chance of limiting the damage and preventing further complications.

Treating peripheral neuropathy

Treatment for peripheral neuropathy depends on the symptoms and underlying cause.

Only some of the underlying causes of neuropathy can be treated. For example, if you have diabetes it may help to gain better control of your blood sugar level, stop smoking and cut down on alcohol.

Nerve pain may be treated with prescribed medications called neuropathic pain agents, as standard painkillers are often ineffective.

If you have other symptoms associated with peripheral neuropathy, these may need to be treated individually. For example, treatment for muscle weakness may involve physiotherapy and the use of walking aids.

Complications of peripheral neuropathy

The outlook for peripheral neuropathy varies, depending on the underlying cause and which nerves have been damaged.

Some cases may improve with time if the underlying cause is treated, whereas in some people the damage may be permanent or may get gradually worse with time.

If the underlying cause of peripheral neuropathy isn't treated, you may be at risk of developing potentially serious complications, such as a foot ulcer that becomes infected. This can lead to gangrene (tissue death) if untreated, and in severe cases may mean the affected foot has to be amputated.

Peripheral neuropathy may affect the nerves controlling the automatic functions of the heart and circulation system (cardiovascular autonomic neuropathy). You may need treatment to increase your blood pressure or, in rare cases, a pacemaker.

Confirming if you have a neuropathy

Some people may need to see a neurologist (a specialist in conditions affecting the nervous system) in hospital for further tests such as:

a nerve conduction test (NCS) – where small metal wires called electrodes are placed on your skin which release tiny electric shocks that stimulate your nerves; the speed and strength of the nerve signal is measured

electromyography (EMG) – where a small needle is inserted through your skin into your muscle and used to measure the electrical activity of your muscles

NCS and EMG are usually carried out at the same time.

Identifying the cause of a neuropathy

Your GP can usually identify the underlying cause of a peripheral neuropathy.

If diabetes is suspected, they can usually make a confident diagnosis based on your symptoms, a physical examination and checking the levels of glucose in your blood and urine.

If you're taking a medication known to cause peripheral neuropathy, your GP may temporarily stop or reduce your dose to see whether your symptoms improve.

If the cause is uncertain, you may be referred to a neurologist for more extensive blood tests to check:

whether you have a rare acquired cause that may be responsible

whether you have a genetic abnormality, such as Charcot-Marie-Tooth disease

You may need a lumbar puncture to test the cerebrospinal fluid (a clear, colourless fluid that surrounds and supports the brain and spinal cord) for inflammation.

Further tests

Occasionally, a nerve biopsy may be carried out as part of your diagnosis. This is a minor surgical procedure where a small sample of a peripheral nerve is removed from near your ankle so it can be examined under a microscope.

It's then checked for changes that could be a sign of certain types of peripheral neuropathy. However, nerve biopsies are rarely needed.

You may also need a scan to look for any underlying cause of your neuropathy, such as:

immunosuppressants – medications that reduce the activity of the immune system

injections of immunoglobulin – mixture of blood proteins called antibodies made by the immune system

However, the underlying cause may not always be untreatable.

Relieving nerve pain

You may also require medication to treat any nerve pain (neuropathic pain) you're experiencing.

Unlike most other types of pain, neuropathic pain doesn't usually get better with common painkillers, such as paracetamol and ibuprofen and other medications are often used.

These should usually be started at the minimum dose, with the dose gradually increased until you notice an effect, because the ideal dose for each person is unpredictable. Higher doses may be better at managing the pain, but are also more likely to cause side effects.

The most common side effects are tiredness, dizziness or feeling "drunk". If you get these, it may be necessary to reduce your dose. Don't drive or operate machinery if you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol.

The side effects should improve after a week or two as your body gets used to the medication. However, if your side effects continue, tell your GP as it may be possible to change to a different medication that suits you better.

Even if the first medication tried doesn't help, others may.

Many of these medications may also be used for treating other conditions, such as depression, epilepsy, anxiety or headaches. If you're given an antidepressant, this may treat pain even if you're not depressed. This doesn't mean your doctor suspects you're depressed.

Lidocaine plaster

This is a large sticking plaster that contains a local anaesthetic. It's useful when pain affects only a small area of skin. It's stuck over the area of painful skin and the local anaesthetic is absorbed into the skin that's covered.

Tramadol

Tramadol is a powerful painkiller related to morphine that can be used to treat neuropathic pain that doesn't respond to other treatments your GP can prescribe.

Like all opioids, tramadol can be addictive if it's taken for a long time. It will usually only be prescribed for a short time. Tramadol can be useful to take at times when your pain is worse.

Common side effects of tramadol include:

feeling sick or vomiting

dizziness

constipation

Treating other symptoms

In addition to treating pain, you may also require treatment to help you manage other symptoms you're experiencing as a result of peripheral neuropathy.

For example, if you have muscle weakness, you may need physiotherapy to learn exercises to improve your muscle strength. You may also need to wear splints to support weak ankles or use walking aids to help you get around.

Other problems associated with peripheral neuropathy may be treatable with medication, such as:

Complications of peripheral neuropathy

Peripheral neuropathy can sometimes cause other medical problems, such as foot ulcers and heart rhythm changes, and blood circulation problems.

These complications vary depending on the underlying cause of the condition.

Diabetic foot ulcer

A diabetic foot ulcer is an open wound or sore on the skin that's slow to heal. These are common in people with diabetic polyneuropathy.

If you have numb feet, it's easy to cut your foot by stepping on something sharp.

An ulcer can also occur if you unknowingly develop a blister caused by badly fitting shoes. If you don't feel any pain, you may continue walking without protecting the blister. If the cut or blister gets worse, it may develop into an ulcer.

High blood sugar can damage your blood vessels, causing the blood supply to your feet to become restricted. A reduced blood supply to the skin on your feet means it receives a lower number of infection-fighting cells, which can mean wounds take longer to heal and can lead to gangrene.

Gangrene

If you do develop a wound infection in one of your feet as a result of peripheral neuropathy, there's a risk this could lead to gangrene (death of part of the skin or underlying tissues).

If gangrene does develop, you may need surgery to remove the damaged tissue (known as debridement) and antibiotics to treat any underlying infection. In severe cases your toe or foot may need to be amputated.

If you have diabetes, you should take extra care of your feet. Get your feet checked regularly by a podiatrist (a medical professional, also known as a chiropodist, who specialises in foot care).

Cardiovascular autonomic neuropathy (CAN)

Cardiovascular autonomic neuropathy (CAN) is another potentially serious problem that's common in people with diabetic polyneuropathy.

CAN occurs when damage to the peripheral nerves disrupts the automatic functions that control your blood circulation and heartbeat.

The two main noticeable symptoms of CAN are:

an inability to exercise for more than a very short period of time

orthostatic hypotension – a type of low blood pressure that can make you feel dizzy or faint when you stand up

Treating CAN

You may be able to control the symptoms of orthostatic hypotension by using a number of self care techniques, such as:

standing or sitting up slowly and gradually

drinking plenty of fluids to increase the volume of your blood and raise your blood pressure

wearing compression stockings to help prevent blood falling back down into your legs

tilting your bed by raising it at the head end

In some cases, medication may be required to treat orthostatic hypotension.

Two widely used medications are:

fludrocortisone – which works by increasing the volume of your blood

midodrine – which works by tightening your blood vessels

A more serious concern with CAN is that your heart may suddenly develop an abnormal pattern of beating (arrhythmia), which could lead to a cardiac arrest, where your heart stops beating altogether.

To prevent this, you may be prescribed medication to help regulate the beating of your heart, such as flecainide, beta-blockers or amiodarone.

If you have CAN, you'll probably need to have regular check-ups so your heart function can be monitored.